Stacy L Deitrick, MACCCSLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA19289 Issued in FL

Practice address

1201 Daly Dr
New Haven, IN 46774-1891

Phone

(260) 749-0413

Fax

(260) 749-2531

NPI assigned

May 5, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1399248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635465600000",
    "number": "1841600459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 SILVER PALM DR APT 203",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347472746",
            "telephone_number": "937-733-6216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 DALY DR",
            "city": "NEW HAVEN",
            "state": "IN",
            "postal_code": "467741891",
            "telephone_number": "260-749-0413",
            "fax_number": "260-749-2531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEITRICK",
        "first_name": "STACY",
        "middle_name": "L",
        "credential": "MACCCSLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-05",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA19289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Creed
• Richard L Cuney Jr., R.PH.
• Allison Laine Daniels, NP
• Valerie L Davis, ATC, LAT
• Brandon L Dearmond, LCSW
• Jasper Paul Downie, D.D.S.
• William J Downie, DDS
• Drayer Physical Therapy Indiana LLC
• East Allen County Schools
• Pamela Ehle

• Speech-Language Pathologist in New Haven, IN
• Providers in New Haven, IN by specialty
• Speech-Language Pathologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.